Six ways we stigmatize the mentally ill

The stigma around mental illness is often worse than the illness itself, Queen's University professor Heather Stuart, the world's first research chair in mental illness and stigma, told the Ottawa branch of the Canadian Mental Health Association Wednesday.

The stigma around mental illness is often worse than the illness itself, says the world’s first research chair into the issue.

Queen’s University professor Heather Stuart spoke Wednesday to the the Ottawa branch of the Canadian Mental Health Association during Mental Health Week.

Stigmatization of the mentally ill is so pervasive, Stuart said, that three-quarters of people with the illness either delay getting treatment or don’t seek treatment at all. She believes there is a place for large awareness campaigns, such as Bell Let’s Talk, which supports Stuart’s research with $1 million over five years, and the Royal Ottawa Foundation for Mental Health’s You Know Who I Am campaign. But Stuart said real change will not happen without more targeted programs to train people in their workplaces and students in school. “It’s something that we are going to have to tackle as a community.”

Stuart said society stigmatizes mental illness in a number of ways.

1. Human rights violations: People with mental illness are the targets of human rights abuses around the world. Abuses might be more visible in poorer countries, where the mentally ill are sometimes confined, even chained. But they also exist in Canada, where between 60 and 90 per cent of prisoners awaiting trial meet the criteria for mental illness, as do 60 per cent of prisoners in some federal penitentiaries. “We took people out of hospitals, but they ended up back in institutions — now they are in jail,” said Stuart. There are other violations, she said, including barriers to voting for many Canadians with mental illness, and the risk of ending up on a police database, which could result in being refused entry the U.S.

2. Gaps in systems of care: Between 35 and 50 per cent of people who are homeless also meet the criteria for mental illness. “We lost a whole generation of people when we moved from hospitals to the community,” said Stuart. Ontario and other provinces shut down or dramatically reduced beds at large psychiatric institutions in recent decades, but community services haven’t kept pace, leaving large numbers of people with mental illnesses in jail or homeless. For some, prison is the fastest, or the only, place they can get access to psychiatric services.

3. Labelling: All sectors of society label mental illness in a way that stigmatizes people, Stuart said. This is especially true in hospitals and other parts of the medical world, she said, and requires training to undo. Something as simple as referring to a patient by the name of a mental illness – schizophrenic, for example – rather than by name has harmful negative effects, she said.

4. Treatment inequalities: People with mental illness have shorter life spans than the general population, and sometimes this is simply due to lack of or poor basic medical treatment for physical health. Sometimes, said Stuart, patient requests for treatment are ignored or delayed while health workers focus on their psychiatric issues.

5. Dehumanizing treatment: Patients often complain that they are treated by health officials and others in ways that dehumanize them — care providers don’t look them in the eye or introduce themselves, for example, or they are excluded from other small human interactions. Sometimes the “bad behaviour” by health workers is more blatant — nurses saying the health system shouldn’t waste resources on patients who don’t want to live, for example. Small efforts can make a big difference, said Stuart. One patient on a gurney in a hospital hallway after attempting suicide, for example, said a nurse walked by, touched her arm and told her she would get through it, which had a positive impact, Stuart said.

6. More research: To get money for programs to help undo systemic stigmatization of the mentally ill, Stuart said, mental health researchers need to do more work to prove the frequency and impact of stigma. She is working with Statistics Canada to develop a way to assess stigma that can be built into national health surveys. She is also working with the Mental Health Commission of Canada on anti-stigma activities including programs that bring people into classrooms to talk to students about their experiences.

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